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Anecdotal evidence suggests that in its first year, KanCare — Kansas’ new privatized system for administering Medicaid — has been a bureaucratic mess.

Marion County’s ambulance service goes around and around with one of the three KanCare contractors to get reimbursed for mileage on emergency transfers from one hospital to another.

The problem is that the emergency transfers aren’t preauthorized by the contractor, ambulance director Steve Smith told county commission on Monday.

Bev Reid, chief financial officer at St. Luke Hospital, said under KanCare, preauthorization can take two weeks. When the state managed Medicaid more directly, preauthorization reliably took 24 hours or less.

Another issue the hospital has is the time the contractors take to process claims. Because companies providing KanCare services are new to Medicaid, hospital staff has to do more follow-up on billing, and rebilling takes three weeks to process.

“We still have some claims out there from January that haven’t been paid yet,” Reid said.

January was the first month of KanCare.

Claims processing has been an issue even for the county health department, which mostly deals with vaccinations that don’t need preauthorization.

Another issue has been unpredictable reimbursement amounts, Reid said. All three contractors are supposed to pay the same, but payments vary from company to company and even from instance to instance with the same company, she said.

Medicaid always has been one of the lowest paying insurers, Reid said, but payment was timely and predictable. Reid is hopeful that as KanCare contractors get more experienced, reliability can be restored.

The new issues with Medicaid couldn’t have come at a worse time for Harvey-Marion County Community Developmental Disability Organization.

With CDDO already having a years-long waiting list, it and its clients are running into more roadblocks to coverage, director Elizabeth Schmidt told commissioners.

At a previous meeting, Schmidt relayed the story of a client who couldn’t get the correct — and prescribed — dose of an anti-seizure medication for her child because she already had other — also prescribed — doses. Using different doses was a crucial part of treating the seizures without making side effects unbearable.